Postnatal Paternal Depression Triggers Behavioral Problems for Sons

Action Points

Be aware that paternal depression, as well as maternal depression, can have a long-term impact on a child's behavior. Know that boys are particularly vulnerable to their father's and mother's moods.

Consider asking about both parent's emotional states during postnatal visits. If a parent shows depressive symptoms, consider referring them to a mental health practitioner.

Be aware that this is the first large study to consider the effects of paternal mood on a child's development and the results need to be replicated elsewhere.

OXFORD, England, June 24-A father's postpartum depression can trigger a son's behavioral problems as a small child.

So reports a British team in the first large study to consider the effects of paternal mood on a son's development. Paternal depression is less likely to affect a daughter's behavior, but girls and boys were both strongly affected in the study by postpartum maternal depression.

The effect of the paternal depression on behavioral problems remained significant even after maternal depression and other factors were taken into account, Paul Ramchandani, MRCPsych, at the University of Oxford and colleagues reported today in The Lancet.

Children whose fathers showed symptoms of depression eight weeks after the child was born were significantly more likely to have conduct problems when they reached the age of 42 months than were children whose fathers were not depressed (HR=1.73, 95% CI, 1.06-2.85). The risk of hyperactivity nearly doubled in these children (HR=1.96, 1.12-3.43).

When the researchers looked at the effects of paternal depression on girls versus boys, they found that a father's mood only had significant impact on boys (HR=2.91, 95% CI 1.77-4.80) for adverse emotional and behavioral outcomes in boys versus (HR=1.38, 95% CI 0.73-2.61) for girls. However, girls and boys were both significantly affected by maternal depression (HR=2.64, 95% CI 1.87-3.71) for adverse outcomes in boys versus (HR=3.00, 95% CI 2.06-4.38) for girls.

A father's depressive symptoms eight weeks after a child's birth remained significant even when the researchers controlled for his emotional state at 21 months, (HR=1.96, 95% CI, 1.12-3.43) for hyperactivity, (HR=1.73, 95% CI 1.06-2.85) for conduct.

The findings emerged as part of a longitudinal population-based study of more than 13,000 mothers and infants born in the Bristol area between April 1991 and December 1992.

Representing the first large study to address the impact of a father's emotional state on their children, it reports the results from several subset analyses that included as many 9,500 children whose mothers and fathers filled out questionnaires on depression. These were filled out at eight weeks, 21 weeks, and 42 weeks after the child's birth, and they assessed the child's behavior at 42 months.

"There are several possible explanations for our findings," wrote Dr. Ramchandani. Depression may alter the way a father interacts with an infant, which has been seen in studies of maternal depression. Genetics could play a role, though that hasn't been the case in maternal depression. Indirect effects, such as the depression negatively impacting interactions between the mother and father, could be a problem. The researchers did not think that a child-to-parent transference was likely, though it could not be ruled out.

In an accompanying commentary, Tytti Solantaus, M.D., of the National Research and Development Center for Welfare and Health in Helsinki, Finland, and Saara Salo of Children's Hospital there wrote, "We do not even know much about father-infant interaction in so-called normal father-infant pairs. Ramchandani and colleagues force us to start from the beginning."

Both the study authors and the commentators noted that one drawback to the study is that all of the assessment was done via questionnaires. For that reason, future studies should include direct observation and interventions.

"Fathers play an important role in the early life and development of their children," concluded the Dr. Ramchandani and colleagues. "In the case of paternal depression, this effect seems especially notable in boys."

Reviewed by
Rubeen K Israni, MD, Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine

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